Four-dimensional volumetric modulated arc therapy (4D VMAT) is a treatment strategy for lung cancers that aims to exploit relative target and tissue motion to improve organ at risk (OAR) sparing. The algorithm incorporates the entire patient respiratory cycle using 4D CT data into the optimization process. Resulting treatment plans synchronize the delivery of each beam aperture to a specific phase of target motion. Stereotactic body radiation therapy treatment plans for 4D VMAT, gated VMAT, and 3D VMAT were generated on three patients with non-small cell lung cancer. Tumour motion ranged from 1.4-3.4 cm. The dose and fractionation scheme was 48 Gy in four fractions. A B-spline transformation model registered the 4D CT images. 4D dose volume histograms (4D DVH) were calculated from total dose accumulated at the maximum exhalation. For the majority of OARs, gated VMAT achieved the most radiation sparing but treatment times were 77-148% longer than 3D VMAT. 4D VMAT plan qualities were comparable to gated VMAT, but treatment times were only 11-25% longer than 3D VMAT. 4D VMAT's improvement of healthy tissue sparing can allow for further dose escalation. Future study could potentially adapt 4D VMAT to irregular patient breathing patterns.
The accuracy of Monte Carlo (MC) simulation results relies on validating the MC models used in the calculations. In this work, a MC model for the NACP-02 plane-parallel ionization chamber was built and validated against megavoltage electron backscatter experiments using materials of water, graphite, aluminium and copper. Electron energies ranged between 6-18 MeV and the chamber's air cavity was at the depth of maximum dose, z(max). A chamber model based on manufacturer's specifications resulted in systematic discrepancies of several percents between measured and simulated backscatter factors. Tuning of the MC chamber model against backscatter factors to improve agreement increased the chamber's front window mass thickness by 35% over the reported value of 104 mg cm(-2) in the IAEA's TRS-398 absorbed dose protocol. The large increase in chamber window mass thickness was verified by measurements on a disassembled NACP-02 chamber. The new backscatter factor results based on the tuned MC NACP-02 chamber model matched the experimental results within 1-2 standard deviations. We conclude therefore that for MC simulations near z(max), tuning of the NACP-02 chamber model against experimental backscatter measurements is an acceptable method for validating the chamber model.
Our investigation demonstrated that the 4D-VMAT system has the potential to improve radiation therapy of periodically moving tumors over 3D-VMAT, gating or tracking methods.
Derived from 2 yr of deliberations and community engagement, Medical Physics 3.0 (MP3.0) is an effort commissioned by the American Association of Physicists in Medicine (AAPM) to devise a framework of strategies by which medical physicists can maintain and improve their integral roles in, and contributions to, health care and its innovation under conditions of rapid change and uncertainty. Toward that goal, MP3.0 advocates a broadened and refreshed model of sustainable excellence by which medical physicists can and should contribute to health care. The overarching conviction of MP3.0 is that every healthcare facility can benefit from medical physics and every patient's care can be improved by a medical physicist. This large and expansive challenge necessitates a range of strategies specific to each area of medical physics: clinical practice, research, product development, and education. The present paper offers a summary of the Phase 1 deliberations of the MP3.0 initiative pertaining to strategic directions of the discipline primarily but not exclusively oriented toward the clinical practice of medical physics in the United States.
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